title: Colonoscopic resection of large colonic polyps--a prospective study.
abstract: Forty-five patients who were referred for surgical resection of large colonic polyps after index colonoscopy were considered for endoscopic polypectomy. Eighteen of these patients were ultimately referred for surgery. Twenty-five patients with 25 large polyps underwent endoscopic polypectomy; there were 9 females and 16 males with a mean age of 69 years. Among the polypectomy patients, polyp size was 3.0-6.0 cm, found mostly in the left colon. There were 21 pedunculated and 4 sessile polyps. Follow-up was carried out for a mean of 48 months (range, 12-171 months). Polypectomy was possible on a single attempt in 12 (48%) cases and in 13 (52%) cases by a piecemeal technique. Pathological examination revealed malignancy in 11 (44%), adenomatous polyp in 11 (44%), and inflammatory, hyperplastic and harmartoma in 1 patient each. Complications included bleeding in 3 (12%) patients and diarrhea and fever in 1 (4%). All complications were successfully treated conservatively without sequellae. Two patients were referred for surgery, 1 with invasion of the base of the polyp and 1 because of a synchronous malignant polyp. During follow-up, 8 metachronous polyps were detected. In 1 of these, a carcinoma was found and treated with endoscopic polypectomy. In conclusion, endoscopic polypectomy of large polyps is safe and can defer surgical treatment. Regular follow-up is required. Endoscopic polypectomy of large polyps should be considered before referral for surgical treatment.
authors.affiliation: Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Bardan
authors.forename: L
authors.initials: L
authors.lastname: Bat
authors.forename: E
authors.initials: E
authors.lastname: Melzer
authors.forename: E
authors.initials: E
authors.lastname: Shemesh
authors.forename: S
authors.initials: S
authors.lastname: Bar-Meir
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome